Provider Demographics
NPI:1346476470
Name:FOUNTAINVIEW PHARMACY
Entity Type:Organization
Organization Name:FOUNTAINVIEW PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-784-2112
Mailing Address - Street 1:3013 FOUNTAIN VIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6132
Mailing Address - Country:US
Mailing Address - Phone:713-784-2112
Mailing Address - Fax:713-784-4310
Practice Address - Street 1:3013 FOUNTAINVIEW
Practice Address - Street 2:SUITE #A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6137
Practice Address - Country:US
Practice Address - Phone:713-784-2112
Practice Address - Fax:713-784-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26431333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy